NDT Advance Access published online on June 13, 2008
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn322
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Icodextrin does not impact infectious and culture-negative peritonitis rates in peritoneal dialysis patients: a 2-year multicentre, comparative, prospective cohort study
1 Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Austria 2 Division of Nephrology, Hospital Puerto Real, Cadiz, Spain 3 Division of Nephrology, Hôpital Bichat, Paris, France 4 Division of Nephrology, The Ipswich Hospital, Ipswich, UK 5 Division of Nephrology, Hospital Juan Canalejo, Coruna, Spain 6 Baxter Healthcare, Brussels, Belgium
Correspondence and offprint requests to: Andreas Vychytil, Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. Tel: +43-1-40400-4495; Fax: +43-1-40400-4499; E-mail: andreas.vychytil{at}meduniwien.ac.at
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Abstract |
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Background. Icodextrin is a glucose polymer derived by hydrolysis of cornstarch. The different biocompatibility profile of icodextrin-containing peritoneal dialysis (PD) solutions may have a positive influence on peritoneal host defence. Furthermore, cases of sterile peritonitis potentially associated with icodextrin have been reported.
Methods. The primary objective of this multicentre, longitudinal, observational, non-interventional, prospective cohort study, which included 722 PD patients, was to evaluate the incidence of overall peritonitis in patients treated with icodextrin-containing PD solutions (ExtranealTM) used during one long-dwell exchange/day compared with those treated with non-icodextrin-containing PD solutions. The secondary objective was to determine if culture-negative peritonitis rates differed between patients treated with icodextrin from two independent manufacturers. All peritonitis episodes were assessed by a Steering Committee in a blind manner.
Results. There was no significant difference between icodextrin-treated and control patients in the adjusted overall, culture-positive or culture-negative peritonitis rates. When stratified by the icodextrin supplier, there was no significant difference in the adjusted rate of culture-negative peritonitis episodes between groups.
Conclusion. Subjects receiving icodextrin as part of their PD regimen experienced neither a higher rate of culture-negative peritonitis nor a lower rate of infectious peritonitis compared with non-icodextrin users. There was no significant influence of the icodextrin raw material supplier on peritonitis rates.
Keywords: biocompatibility; glucose degradation products; glucose polymer; peptidoglycan; sterile peritonitis
* Sites and members of the Extraneal Peritonitis Study Group are listed in the Appendix.
Received for publication: 28.12.07
Accepted in revised form: 19. 5.08